Group-Based Mindfulness for Patients with Chronic Low Back Pain in the Primary Care

项目摘要 OPTIMUM（使用正念优化医疗环境中的疼痛治疗）是一项实用的临床试验 (PCT)基于正念的压力减轻（MBSR）治疗慢性腰痛（cLBP）， 远程医疗尽管有证据表明正念减压疗法在减轻疼痛和改善功能方面有效， 仍然未得到充分利用，尚未纳入常规临床护理。消除融合障碍 的MBSR在初级保健和确定MBSR在现实生活中的有效性，我们正在进行优化 在三个地点：新英格兰最大的安全网医院，北卡罗来纳州联邦合格的健康中心， 卡罗莱纳和匹兹堡的一个大型学术健康中心。这些网站为大量服务不足的 以及不同的患者群体。为了使OPTIMUM获得成功，参与者必须， 诊所和相关利益相关者充分参与该计划，招聘及时， 成功通过这一补充，我们将大大扩大患者和利益相关者的参与， 解决征聘和留用问题以及今后的传播工作。 在目标1中，我们将扩大OPTIMUM社区咨询委员会（CAB），以包括更多的患者，临床 人员，医疗管理人员，倡导团体和正念组织代表。 在整个试验过程中，CAB将每月举行一次会议，成员将接受培训， 作为利益相关者的有效性。在目标2中，将招募入组OPTIMUM试验的cLBP患者， 参加季度焦点小组，就改善征聘的战略提出自己的观点， 潴留为了扩大利益相关者对参与工作的看法，我们将 采访一系列多层次的利益相关者，包括供应商，疼痛倡导团体，医疗保健 管理员和付款人。在Aim 3中，我们将与Story Booth（一个由“通往成功之路”领导的项目）合作。 学习健康系统网络），以获得未参与研究的cLBP患者的观点。 这些故事将为我们的审判参与工作提供信息，因为预计听到更多的声音， 包括讲西班牙语的患者，将导致识别招募的额外障碍， 实施. 我们的方法遵循基于社区的参与性研究的原则，以促进更大的 可持续性以及社区对OPTIMUM的接受度。持续的数据分析将为迭代 完善协议、优化招聘、最大限度地留住人才并为未来实施做好准备的流程 和传播。

PROJECT ABSTRACT OPTIMUM (Optimizing Pain Treatment In Medical settings Using Mindfulness) is a pragmatic clinical trial (PCT) of mindfulness-based stress reduction (MBSR) for chronic low back pain (cLBP) delivered via telemedicine. Despite evidence of effectiveness for MBSR at decreasing pain and improving function, it remains underutilized and has not been embedded into routine clinical care. To address barriers to integration of MBSR in primary care and determine MBSR effectiveness in real-life settings, we are conducting OPTIMUM in three sites: the largest safety net hospital in New England, federally qualified health centers in North Carolina and a large academic health center in Pittsburgh. These sites serve large numbers of underserved people as well as a diverse patient population. For OPTIMUM to be successful it is imperative that participants, clinics, and relevant stakeholders be fully engaged in the program, and that recruitment is timely and successful. Through this supplement we will significantly expand patient and stakeholder engagement to fully address recruitment and retention issues as well as future dissemination efforts. In Aim 1, we will expand the OPTIMUM Community Advisory Board (CAB) to include more patients, clinical personnel, healthcare administrators, and advocacy group and mindfulness organization representatives.The CAB will meet monthly throughout the course of the trial, and members will receive training to increase their effectiveness as stakeholders. In Aim 2, persons with cLBP enrolled in the OPTIMUM trial will be recruited to participate in quarterly focus groups to provide their perspectives on strategies to improve recruitment and retention. To increase the breadth of stakeholders that provide perspectives on engagement efforts, we will interview a range of multi-level stakeholders, including providers, pain advocacy groups, healthcare administrators, and payors. In Aim 3 we will partner with Story Booth (a project led by the Path Towards a Learning Health System network) to obtain perspectives from persons with cLBP not participating in the study. These stories will inform our trial engagement efforts as it is expected that hearing a larger number of voices, including Spanish-speaking patients, will result in the identification of additional barriers to recruitment and implementation. Our approach is informed by principles of Community-Based Participatory Research, to promote greater sustainability as well as community acceptance of OPTIMUM. Continuous data analysis will inform an iterative process to refine protocols, optimize recruitment, maximize retention, and prepare for future implementation and dissemination.